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DR POOJA MUKUL MD REHABILITATION PHYSICIAN TECHNICAL CONSULTANT BMVSS,JAIPUR ,J FOOT ORGANIZATION & CLINICAL DIRECTOR CENTER FOR RECONSTRUCTION & REHABILITATION JAIPUR 1 INTRODUCTION y The JAIPUR FOOT is an original research product of Jaipur ,INDIA INDIA y The Th ffoot was d developed l d in i response to specific ifi socio‐ i cultural needs of Indian Amputees ,however the design that evolved has features that make it suitable for use anywhere in the world. HISTORY INDIA Pune Mumbai Image by MIT OpenCourseWare. 3 EVOLUTION Jaipur To overcome this problem, a centre was set up in Jaipur, India. India INDIA Pune Mumbai Image by MIT OpenCourseWare. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 4 EVOLUTION y JAIPUR centre started providing conventional lower li b prostheses. limb h y Rejection rates ‐HIGH 5 EVOLUTION ANALYSIS OF REJECTION The reasons were not technical OR biomechanical BUT Socio‐cultural 6 The team at Jaipur centre realized li d th t that b id besides functional aspects, socio‐ economic and cultural demands of amputees needed to be addressed. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 7 PROSTHETIC FOOT y y y y y y Look like a human foot L k lik Permit squatting Adapt to uneven terrain Should be waterproof Permit barefoot walking g Permit use within footwear y Should be affordable y Should be made of locally available materials Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 8 PROSTHETIC FOOT – CONCEPT & DESIGN OBJECTIVES 1. It should look like a normal foot. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 9 PROSTHETIC FOOT – CONCEPT & DESIGN 2. Th hould he exterior sh ld be water proof and durable . 3. It sh hould ld all llow enough h dorsiflexion to permit the amputee to squat. squat 4. It should permit certain amount of transverse rotation of the foot on the leg. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 10 PROSTHETIC FOOT – CONCEPT & DESIGN It should suff h ld have h fficient range of inversion and eversion to allow the foot to adapt to uneven terrain. 6. It should be inexpensive. 7 It should made of locally 7. y available materials. 5. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 11 EVOLUTION SACH FOOT TO JAIPUR FOOT 12 SOLID ANKLE CUSHION HEEL ((SACH)) Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 13 JAIPUR FOOT Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 14 JAIPUR FOOT y The JF is a non‐articulated foot –ankle assembly . y It I consists i off three h structurall bl blocks k replicating li i normall foot anatomy. y The Th fforefoot f & hindfoot hi df are made d off microcellular i ll l rubber and the ankle block is of light wood. y These Th three h blocks bl k along l with i h the h toes are bound b d together by tyre cord and encapsulated in skin colored cushion hi compound. d y This structure is then vulcanized at 120 ⁰ under 23 psi f 30 minutes. for i t JAIPUR FOOT RANGE OF MOTION Dorsiflexion : Heel compression : Pronation : Supination : Axial Internal Rotation : Axial External Rotation : 20º ‐ 35º 35 .8 mm to 2.8 mm. 26º ‐ 29 26 29º 15º ‐ 22º 10º ‐ 12º 4º ‐ 8º POST FITTING TRAINING y Weight bearing surface y Peer Training 17 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti Jaipur Foot Organization, Jaipur, India. Used with permission. Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 20 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 21 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 22 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 23 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 24 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 25 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 26 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 27 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 28 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 29 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 30 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 31 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 32 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 33 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 34 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 35 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 36 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 37 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 38 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 39 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 40 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 41 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 42 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 43 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 44 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 45 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 46 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 47 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 48 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 49 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 50 Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 51 JAIPUR FOOT :Biomechanical Analyysis A comparative study was conducted by Klenerman et al at Liverpool,U.K. Liverpool,U K Two shock absorption variables‐ Impact Peak Force Impact Load Rate Four gait style variables – Propulsive Force Peak Support Impulse Braking Impulse Propulsive Impulse were studied. studied JF : LIVERPOOL STUDY Th study The d concluded l d d– “ The performance of the Jaipur Foot is more natural and nearer to the normal foot as compared d to the h SACH and dS Seattle l F Foot.”” INTERNATIONAL STANDARDS ISO ISO‐10328 8 VETERANS ADMINISTRATION PROSTHETIC CENTER STANDARDS FOR FOOT & ANKLE ASSEMBLIES 54 STATUS OF JAIPUR FOOT DOES NOT WHOLLY CONFORM TO INTERNATIONAL STANDARDS 55 ACCEPTANCE IN THE DEVELOPED WORLD UNACCEPTABLE CRAFTSMANSHIP & FITTING – POOR IN 86% PATIENT ACCEPTANCE – 94% HOW ILLOGICAL /CONTRADICTORY ! 56 INTERNATIONAL ACCEPTANCE DEVELOPING WORLD Afganistan Bangladesh Dominican Republic Honduras Indonesia Malawi Nigeria Nigeria Nepal Kenya Pakistan Panama Pa nama Philippines Papua New Guinea 57 INTERNATIONAL ACCEPTANCE DEVLOPING WORLD Rwand da Sudan Trinidad Vietnam Zambia Zimbabwe Zimbab we Somali lia Mozambique Columbia Sierra Leone 58 TIME MAGAZINE(Fall ( 1997)) ‘ People who live inside the World’s many war zones from Afghanistan to Rwanda may never have heard of New York or Paris but they are likely to know to a town in northern India called Jaipur. Jaipur Jaipur is famous in strifetorn areas as the birthplace of an extraordinary prosthesis or artificial limb,, known as the JJaipur p p foot,, that has revolutionized life for millions of landmine amputees. p The beautyy of the Jaipur p foot is its mobilityy – those who wear it can run, climb trees and pedal bicycles – and its low price.’ 59 COUNTRIES AWAITING ASSISTANCE y Iraq y Haiti y Sri Lanka y Chechnya y Fiji y Tu Turkey rkey y Senegal 60 JF STATUS THE JAIPUR FOOT WAS DEVELOPED IN 1968 . RESEARCH HAS BEEN ONGOING TO IMPROVE ON THE DESIGN. SOME ASPECTS THAT STILL REMAIN TO BE ADDRESSED ARE : 1. JAIPUR FOOT IS NOT AVAILABLE IN NTERNATIONAL STANDARD SIZES SIZES. 2. JAIPUR FOOT IS NOT COMPATIBLE WITH DESIGNS OF WESTERN LIMBS. 3. JAIPUR FOOT IS HEAVIER THAN THE SET INTERNATIONAL STANDARDS. 4. JAIPUR FOOT STILL DOES NOT COME WITH QUALITY ASSURANCE CERTIFICATION CERTIFICATION. JF : CONVOLUTION IN RESEARCH DESIGN OF THE JF HAS STOOD THE TEST OF TIME. TIME HENCE ALL RESEARCH HAS TO GYRATE AROUND THE BASIC STRUCTURE & ITS FUNCTIONAL CHARACTERISTICS . FUTURE COURSE y SIZING THE JAIPUR FOOT TO MEET INTERNATIONAL STANDARDS LAID DOWN BY THE VETERANS ADMINISTRATION PROSTHETIC SERVICES,NEW YORK. y DESIGNING THE JAIPUR FOOT TO BE COMPATIBLE WITH THE WESTERN PROSTHETIC DESIGNS. DESIGNS y MATERIAL MODIFICATIONS TO REDUCE WEIGHT AND INCREASE DURABILITY. DURABILITY y STANDARDIZING TESTING EQUIPMENT FOR QUALITY ASSURANCE. ASSURANCE Jaipur Foot & Limb Technology BMVSS SURVEY -Patient accepptance rate of Jaip pur Limb - 98.7% Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 64 Jaipur Foot & Limb Technology ISPO Retrospective Study –Patient acceptance rate of Jaipur Limb- 94% (JPO Volume 28 No.3) Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 65 FINAL WORD USER REACTION & USER ACCEPTANCE 66 THANK YOU 67 BMVSS‐ As an organization BMVSS y Established in 1975 at Jaipur y 19 Centres across th he country y Open door and patient friendly policy y Delivery System y Free assistance not charity y Academic activities y R&D 68 BMVSS‐ Achievements BMVSS y Provided 59 prostheses in the first year of its inception inception. y Today provides more than 20 thousand prostheses in a year (largest limb fitting centre in the world) y Total beneficiaries are > 1.1M 69 J i SSocket k Hi Jaipur History Aluminum Sockets HDPE Sockets Total Contact Sockets 70 Fi Phase‐ First Ph Al i Aluminum SSockets k Aluminium Sockets (1968–1987) At that time the demand was huge, services were limited lack of trained manpower lack of materials non‐availability il bili off any other suitable technique huge g resource of artisans h i traditional having di i l knowlledge d of technology Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 71 Fi Phase‐ First Ph Al i Aluminum SSockets k Aluminium Sockets (1968–1987) ease of Fabrication able to withstand climate changes easily available in the local market Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 72 Fi Phase‐ First Ph Al i Aluminum SSockets k Aluminium Sockets Al i i S k ((1968–1987) 68 8 ) The combination of Jaipur Foot and Aluminum socket: Really filled the void and became very popular Was a cross breed of standard PTB and conventional plug fit sockets Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 73 Fi Phase‐ First Ph Al i Aluminum SSockets k Aluminium Sockets Al i i S k (1968–1987) ( 68 8 ) This cross breed design suited to amputees in conditi ditions Indian climatic Could be fabricated in an hour Delivery time significantly i ifi l Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. was reduced Fi Phase‐ First Ph Al i Aluminum SSockets k Aluminium Sockets Al i i S k (1968–1987) ( 68 8 ) This lead to unprecedented rise in the number of prosthetic fitment And Lowering of cost Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 75 Second Phase‐HDPE Sockets High density polyethylene (HDPE) pipes have the properties of: Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. hig gh imp pact streng gth high flexural strength high fatigue strength are inert withstand climate changes easy to handle good moldability available in the market 76 Second Phase‐HDPE Sockets HDPE Open Ended Sockets (1987‐1995) Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. usiing conventiionall POP wrap cast technique seamless light in weight fabrication time <one hour cost‐effective material 77 Third Phase – Total Contact Total Contact Sockets (1995 – continuing) Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. using conventional POP Wrap cast technique inner socket was made of HDPE or PP Co‐polymer sheets 78 Jaipur Foot & Limb Technology In‐process alignment technique to incorporate the total contact socket with shank Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 79 Jaipur Foot & Limb Technology Alignment Transfer technique is also used to align the inner socket with shank Courtesy of Dr. Pooja Mukul, Bhagwan Mahaveer Viklang Sahayata Samiti - Jaipur Foot Organization, Jaipur, India. Used with permission. 80 BMVSS R&D BMVSS‐ 81 Standards International Standards known as ISO:10328 Indian Standards known as BIS Standards 82 ISO:10328 ped in collaboration with y These standards were develop ISPO and are very rigorous and strict y Do not take care of normal human req quirements and meant for specific Prosthetic feet y Testing g Load is app pplied onlyy at forefoot and heel y No dorsiflexion, inversion or eversion 83 ISO:10328 y In an recent article have l published bl h d by b ISPO, the h authors h h observed that lab test as per ISO :10328 showed little wear to t the th foot f t sole l y We should develop our own standards considering the gross physical, h i l social i l and d cultural l l needs d off our people. l y And standards should be such that even other countries should h ld copy them h 84 BIS Standards – Prosthetic Feet y At present there are no standards available for prosthetic feet in India y Draft standards for SACH foot are in circulation for comments y We have applied to BIS to formulate standards for Jaipur Foot 85 BIS Standards – Sockets Sockets are custom made 86 BIS Standards – Calipers y The standard for calipers is very old y Thermoplastics p are being g used extensivelyy and p proving g very effective y Standards should be revised in accordance with the gross requirements of our people 87 BIS Standards – other aids y BIS standards for tricycle, wheelchairs, crutches and other items are very strict and good. y Scope of customization should be there to enhance the effectiveness of assistive devices 88 BIS Standards BIS Standards y In the end, end our congratulations and thanks to BIS for developing standards for prosthetic and orthotic and rehabilitation aids and appliances. pp y And revising them from time to time. 89 MIT OpenCourseWare http://ocw.mit.edu EC .722 Special Topics at Edgerton Center:Developing World Prosthetics Spring 2010 For information about citing these materials or our Terms of Use, visit: http://ocw.mit.edu/terms.
